Physical diagnosis....

We'll review the "classic" physical signs...that with great certainty, will be asked on the
board exam. Suggest, you memorize all of them.



Q: What is a Kussmaul Sign?


A: It is distention of the neck veins on inspiration. (This occurs in any condition that impedes
right ventricular filling, e.g. RV Infarction/CONSTRICTIVE PERICARDITIS/right heart
failure.


Q: What is Pulsus Alternans?


A: It is alteration in the amplitude (palpable force) of each pulse, due to left ventricular
contractive weakness. Each pulse is regular. Main conditions causing this are CARDIAC
TAMPONADE and severe LV decompensation.



Q: What is Tinel's Sign?


A: It is a common finding in patients with CARPAL TUNNEL SYNDROME. The sign
itself refers to "tapping" of the median nerve at the volar aspect of the wrist. This
causes, paresthesia (pins& needle senation). HINT: "T"apping---"T"inel's !!!!


Q: What is the Drop Arm Sign?


A: It is seen in patients with ROTATOR CUFF TEAR. The patient's arm is abducted
to 180 degrees. When asked to gently let down the arm....it will just suddenly drop
when reaching about 90 degrees....thus confirming the tear.



Q: What is an Iliopsoas Sign?


A: It is a physical finding suggestive of ACUTE APPENDICITIS. It is elicited by asking
the patient to raise the right leg against resistance. The pain...is
is caused by "rubbing" of the inflammed appendix against the inner peritoneal wall.



Q: What is a Cullen's Sign?


A: It is seen with conditions causing hemoperitoneum. Classically, it's associated with
NECROTIZING PANCREATITIS. The finding is a PERIUMBILICAL ecchymotic
like discoloration of the skin.


Q: What is Kehr's Sign?


A: Violent, severe pain in the left shoulder of a patient with RUPTURED SPLEEN.



Q: What is Chvostek's Sign?


A: It is an elicitation of unilateral facial irritability, by gently tapping over the facial
nerve, just anterior to the ear. It will cause facial grimacing, due spasm of the orbucularis
oris or oculi muscles. It is a sign of TETANY (HYPOCALCEMIA).





Keep up the good work!!! Study hard...reap the benefits later.....